Unit VII – Urinary

Chapter 23

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Co 23
Fig. 23.1

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Diaphragm
11th and 12th ribs
Adrenal gland
Renal artery
Renal vein
Kidney
Vertebra L2

Aorta
Inferior vena cava

Ureter

Urinary bladder

Urethra

(a) Anterior view (b) Posterior view

Fig. 23.2
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H O
N C
H H H 2N NH2

Ammonia Urea

O NH
H
C N C
HN C
C O HN N CH3
C C
N N C CH2
O
H H O

Uric acid Creatinine

Fig. 23.3

Copyright © McGraw-Hill Education. Permission required for reproduction or display.

Anterior
Small intestine Stomach

Colon

Pancreas

Renal artery Inferior vena cava

and vein Aorta
Peritoneum L1
Ureter
Spleen
Kidney

Hilum
Fibrous capsule
Perirenal
fat capsule
Renal fascia Lumbar muscles

Posterior
Fig. 23.4

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Renal cortex

Pyramid of renal
medulla

Minor calyx

Major calyx

Renal column

Renal artery

Renal sinus

Renal vein

Renal pelvis

Ureter
(a) (b)

a: © McGraw-Hill Education/Rebecca Gray, photographer/Don Kincaid, dissections

Fig. 23.5

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Cortical radiate
artery and vein
Aorta Inferior vena cava
Interlobar
artery and vein

Segmental Renal a. Renal v.

Renal artery
medulla
Segmental a.

Renal
artery Interlobar a. Interlobar v.
and
vein
Renal Arcuate a. Arcuate v.
cortex

Cortical radiate a. Cortical radiate v.

Arcuate Afferent arteriole Peritubular capillaries Vasa recta

artery
and vein
Glomerulus Efferent arteriole

(a) (b)
Fig. 23.6 Copyright © McGraw-Hill Education. Permission required for reproduction or display.
Cortical nephron

Afferent arteriole

Juxtamedullary nephron Glomerulus

Efferent arteriole
C
o
r PCT
t
e
x DCT Cortical radiate
artery

Cortical radiate
Peritubular
vein
capillaries

Corticomedullary
junction

Arcuate artery
Arcuate vein
Vasa recta

M
e
d Collecting duct
u
l
l Nephron loop
a
Fig. 23.7

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Glomerular capsule:
Key
Parietal layer
Flow of blood
Capsular
Flow of filtrate space Proximal convoluted
Podocytes of tubule
visceral layer
Afferent Peritubular
arteriole Glomerulus capillary

Blood Glomerular
flow capillaries

Glomerular capsule:
Proximal
convoluted Visceral layer
Efferent Capsular space
tubule
arteriole Parietal layer
Glomerular
capillaries
Afferent arteriole
(podocytes
and capillary Macula densa
wall
Nephron loop
Blood flow removed)
(a) (b) 100 µm
b: © McGraw-Hill Education/Al Telser, photographer
 Copyright © McGraw-Hill Education. Permission required for reproduction or display.
Fig. 23.8

Renal capsule

Renal Nephron
cortex
Collecting duct

Renal
medulla
Minor
calyx
(a)
Renal
papilla
Renal corpuscle: Cortical nephron
Glomerular capsule
Glomerulus

Efferent
arteriole Convoluted tubules
(PCT and DCT)

Afferent
arteriole
Juxtamedullary
nephron
Distal
Proximal
convoluted
convoluted
tubule (DCT) Cortex
tubule (PCT)
Medulla

Nephron loop:
Descending limb
Collecting
Ascending limb duct (CD)

Thick segment

Thin segment

Nephron
Key loops

Flow of blood
Flow of tubular fluid

(b)

Collecting
duct

Papillary
duct

(c)
Fig. 23.9 Copyright © McGraw-Hill Education. Permission required for reproduction or display.
Blood flow

1 Glomerular filtration Renal corpuscle

Creates a plasmalike
filtrate of the blood

Flow of filtrate

2 Tubular reabsorption
Removes useful solutes
from the filtrate, returns Peritubular
them to the blood capillaries

3 Tubular secretion
Removes additional
wastes from the blood,
adds them to the filtrate
Renal tubule

4 Water conservation H 2O
Removes water from the
urine and returns it to H 2O
blood; concentrates
wastes H 2O

Urine
Fig. 23.10 Copyright © McGraw-Hill Education. Permission required for reproduction or display.

Efferent
arteriole

Podocyte
cell body

Glomerulus

Pedicels
(separated by
narrow
filtration slits)

Afferent
arteriole

(a) 100 µm (b) 5 µm

Capsular space

Blood plasma

Erythrocyte

Podocytes
Foot processes
Basement membrane
Endothelial cell

Filtration pore

Filtration slits

(c) 0.5 µm
a: © Steve Gschmeissner/Getty Images; b: © Don W. Fawcett/Science Source;
c: © Biophoto Associates/Science Source
Fig. 23.11

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Endothelial cell of
Turned back:
glomerular capillary
Blood cells
Plasma proteins Basement membrane
Large anions
Protein-bound Filtration slit
minerals and
Filtration pore
hormones
Most molecules Foot process of
> 8 nm in podocyte
diameter Passed through filter:
Water
Electrolytes
Glucose
Amino acids
Fatty acids
Vitamins
Urea
Uric acid
Creatinine

Bloodstream Capsular space

Fig. 23.12 Copyright © McGraw-Hill Education. Permission required for reproduction or display.

BHP 60 out

COP 32 in
NFP 10 out
CP 18 in

Blood hydrostatic pressure (BHP) 60 mm Hgout

Colloid osmotic pressure (COP) –32 mm Hgin
Capsular pressure (CP) –18 mm Hgin
Net filtration pressure (NFP) 10 mm Hgout
Fig. 23.13 Copyright © McGraw-Hill Education. Permission required for reproduction or display.

Sympathetic
nerve fiber

Podocytes
Mesangial cells
Granular
Efferent arteriole cells

Afferent arteriole
Smooth muscle
cells
Macula densa
Nephron
loop
Fig. 23.14 Copyright © McGraw-Hill Education. Permission required for reproduction or display.

High GFR Reduced GFR

Increased NaCl Afferent arteriole

load in nephron loop constricts

Macula densa Adenosine stimulates

secretes ATP granular cells

Mesangial cells
metabolize ATP
to adenosine
Fig. 23.15 Copyright © McGraw-Hill Education. Permission required for reproduction or display.

Drop in blood Liver

pressure

Angiotensinogen
(453 amino acids long)

Renin

Kidney Angiotensin I
(10 amino acids long)

Angiotensin-
converting
enzyme (ACE)

Angiotensin II Lungs
(8 amino acids long)

Cardiovascular
Hypothalamus
system Adrenal
cortex

Aldosterone

Kidney

Vasoconstriction

Thirst and Sodium and

drinking water retention
Elevated blood
pressure
Fig. 23.16

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Peritubular Tissue
capillary fluid Tubule epithelial cells Tubular fluid

Glucose Sodium–glucose
Na+ transporter
ATP (SGLT) (symport)
Na+ Glucose
Na+ –K+ pump Na+
K+
H+ Na+–H+ antiport
ADP + Pi
K+ Cl–
Anions Cl––anion antiport
Cl–
K+ –Cl–
H 2O Aquaporin
symport
Tight junction
Solvent drag
Transcellular route Brush H2O, urea, uric acid,
Paracellular route border Na+, K+, Cl–, Mg2+,Ca2+, Pi
Fig. 23.17 Copyright © McGraw-Hill Education. Permission required for reproduction or display.

1 Angiotensin II 2 Constricts afferent and

secreted especially efferent arterioles

3 Maintains or increases
glomerular blood pressure
and glomerular filtration
and

4 Reduces blood pressure

in peritubular capillary

H 2O

5 Reduces resistance to
tubular reabsorption

6 Tubular reabsorption
increases

7 Urine volume is less

but concentration is high
Fig. 23.18 Copyright © McGraw-Hill Education. Permission required for reproduction or display.

Normoglycemia Hyperglycemia

Glomerular
filtration

Glucose-
transport
protein

Glucose reabsorption

(a) Normal (b) Increased

urine volume, urine volume,
glucose-free with glycosuria
Fig. 23.19 Copyright © McGraw-Hill Education. Permission required for reproduction or display.

Tubular fluid
(300 mOsm/L)

300 Cortex
Medulla
Osmolarity of tissue fluid (mOsm/L)

600 H 2O

H 2O
Collecting
duct
900
H 2O

Nephron
H 2O
loop

1,200
H 2O

Urine
(up to 1,200 mOsm/L)
Fig. 23.20 Copyright © McGraw-Hill Education. Permission required for reproduction or display.

1 More salt is continually

added by the PCT.

300 100

5 The more salt that

is pumped out of the
ascending limb, the
saltier the ECF is in
the renal medulla.
200
2 The higher the osmolarity 400 Na+ Na+
of the ECF, the more water K+ K+
leaves the descending limb Cl– Cl–
by osmosis.
H 2O
H 2O 600 Na+ 400 Na+
K+ K+
Cl– Cl–
H 2O
Na+
H 2O K+ Na+
Cl– K+
Cl–
700
3 The more water that leaves 900 H 2O 4 The saltier the fluid in the
the descending limb, the ascending limb, the more
saltier the fluid is that salt the tubule pumps into
remains in the tubule. the ECF.

1,200
Fig. 23.21

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Osmolarity of
ECF
(mOsm/L) 300

100
300 300 300
300
100
300
200
Cortex
400 Medulla Na+ 400
400
K+
Cl– Na+
200
K+
Cl– 400
Urea Na+ 500
H 2O H 2O
600 K+ Urea
600 Cl– 400 Na+ 600
K+
H 2O NaCl NaCl
Cl– Urea
Na+
K+ 600
700
H 2O 400
Cl– Urea H 2O H 2O
900
900
Key Urea 900
700 NaCl NaCl
900 Urea
Active transport
Urea
1,200
Diffusion through H 2O
1,200 a membrane channel 1,200
1,200

Nephron loop Collecting duct Vasa recta

Table 23.1
Fig. 23.22 Copyright © McGraw-Hill Education. Permission required for reproduction or display.

Glucose Na+
Amino acids K+
Protein Ca2+
Vitamins Mg2+ Na+
Lactate Cl– Cl–
Urea HCO3– HCO3–
Uric acid H 2O H 2O
PCT DCT

H+
K+
Urea H+
NH4+
Uric acid NH4+
Creatinine Some drugs
Na+
K+
Nephron loop: Cl–
Descending limb
Ascending limb Collecting
duct

H 2O
H 2O
Urea
Urea

Key
Tubular
reabsorption
Tubular
secretion
Table 23.2
Fig. 23.23 Copyright © McGraw-Hill Education. Permission required for reproduction or display.

Ureter
Ureter

Detrusor
Rugae
Detrusor
Ureteral muscle
openings Ureteral
openings

Trigone
Trigone

Internal urethral
Urethra sphincter
Prostate
Urogenital
Prostatic urethra
diaphragm
External urethral Membranous Urogenital
External urethral
sphincter urethra diaphragm
orifice
Bulbourethral External urethral
(a) Female gland sphincter

Spongy (penile)
urethra

Penis

External urethral orifice

(b) Male
Fig. 23.24

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From pons Involuntary micturition reflex

To pons From 1 Stretch receptors detect filling of

and cerebrum 5 6 7 cerebral cortex bladder, transmit afferent
signals to spinal cord.
2 Signals return to bladder from
spinal cord segments S2 and S3
via parasympathetic fibers in
pelvic nerve.
Pelvic nerve
3 Efferent signals excite
Sensory Motor detrusor muscle.
fiber fiber
4 Efferent signals relax internal
Full Sacral segments urethral sphincter. Urine is
urinary bladder of spinal cord involuntarily voided if not
inhibited by brain.

S2 Voluntary control
2
5 For voluntary control, micturition
1 center in pons receives signals
S3
from stretch receptors.
6 If it is timely to urinate,
S4
pons returns signals to
Para- spinal interneurons that
3 sympathetic excite detrusor and relax
Stretch ganglion in
receptors internal urethral sphincter.
bladder wall Urine is voided.
Motor fibers to 7 If it is untimely to urinate,
detrusor muscle signals from cerebrum excite
4
Internal urethral spinal interneurons that
sphincter Prostate keep external urethral
sphincter contracted. Urine
External urethral is retained in bladder.
sphincter 8 If it is timely to urinate, signals from
8 Somatic motor fiber
Urethra of pudendal nerve cerebrum inhibit sacral neurons
that keep external sphincter
Root of penis closed. External urethral sphincter
relaxes and urine is voided.
Table 23.3
Fig. 23.25 Copyright © McGraw-Hill Education. Permission required for reproduction or display.

Thermometer

Dialysis Dialysis
tubing fluid

Artery
Vein
Shunt
To
drain
Blood
pump

Flow
Bubble meter
trap Cutaway view
of dialysis
chamber
© Hank Morgan/Science Source
Page 917 ALL SYSTEMS
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Excretes metabolic wastes to prevent poisoning of the tissues; maintains fluid, electrolyte, and acid–base
balance necessary for homeostasis

INTEGUMENTARY SYSTEM CIRCULATORY SYSTEM

Kidneys affect blood pressure more than
Fluid balance maintained by
any other organ but the heart and regulate
the kidneys is essential for
blood composition; renal dysfunction can
normal secretion of sweat.
cause electrolyte imbalances that affect
the cardiac rhythm.

SKELETAL SYSTEM LYMPHATIC/

Calcitriol synthesis IMMUNE SYSTEM
and other roles of the
Acidity of urine provides
kidneys in calcium and
nonspecific defense against
phosphate homeostasis urinary tract infections; renal
are necessary for normal
failure burdens lymphatic system
bone deposition and
by creating fluid retention and
maintenance.
edema.

MUSCULAR SYSTEM RESPIRATORY SYSTEM

Renal control of Na+, K+, and
Respiratory rhythm is sensitive
Ca2+ balance is important
to acid–base imbalances
for muscle excitability and
that may result from renal
contractility.
dysfunction.

NERVOUS SYSTEM DIGESTIVE SYSTEM

Renal control of Na+, K+, and Ca2+
Kidneys excrete toxins absorbed
balance is important for neuron
by intestines; kidneys excrete
signal generation, conduction,
metabolites generated by the
and synaptic transmission.
liver; calcitriol secreted by the
kidneys stimulates calcium
absorption by the small intestine.

ENDOCRINE SYSTEM
Kidneys secrete erythropoietin,
initiate the synthesis of angiotensin
II, indirectly stimulate aldosterone REPRODUCTIVE SYSTEM
secretion, and clear hormones and Male urethra serves as common
their metabolites from the body. passage for urine and semen;
maternal urinary system
excretes fetal wastes.

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